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ABSTRACTBackground: Maternal deaths as a global public health problem and urgent to be addressed through the launch of the Safe Motherhood program. UN Resolution on universal health coverage (Universal Health Coverage) is an important resolution and urged all countries to develop a health system with equitable access and affordable cost. This is one of the programs to reduce MMR and IMR. Based on research in three countries, namely Burkina Faso, Ghana and Tanzania also had a strong effort to improve the quality of maternal and neonatal health (MNH) In addition, these three countries are also striving to improve the performance and motivation of the provider. In Indonesia, according to Ministry of Health Decree No. 59 Year 2014 About the standard of health care, require midwives in cooperation with BPJS through a network of family doctors who have been appointed to make the deal as one of the Government's aim to improve maternal and child health (MCH).Methods: This study is a qualitative research design of phenomenology. Data collection is carried out by the method of in depth review or directly using the guidelines of unstructured interviews, and open questions midwives practice independently as a unit of analysis. Samples or informants taken up to a certain saturation or have reached sufficient number until there is no more data that needs to be explored. Triangulation of data include interview with the chairman of the Indonesian Midwives Association (IBI). Midwife verifiers and family doctor.Results: The results showed that midwives have a bad perception of the delivery package BPJS today. The reason is partly that the mechanism of the claims made package, complicated claim procedures and disbursement process long and low birth rates. So the motivation BPM in cooperation with the current BPJS is relatively small. The phenomenon that researchers have found that there are several midwife, although still tied to cooperation with BPJS but not serving patients with BPJS. Other phenomena that is the BPM want to directly contracted by with BPJS without a network of family doctors. This is due to lack of socialization of BPJS for strengthening primary care program that is currently being initiated by the government.Conclusions: The perception of Independent Midwife Practice against BPJS delivery package is still bad. Although the objective of the government is quite good, but there is still need for evaluation and dissemination as an effort to strengthen the primary care for BPM in the sustainability of cooperation in networks of family doctors in the hope that the package delivery mechanism is not paid in package and increase of the delivery service tarif rates between 800 thousand to 1.5 million IDR. Keywords: Independent Midwife Practice, Delivery Package, BPJS ABSTRAKLatar Belakang: Kematian ibu sebagai masalah kesehatan masyarakat global dan mendesak untuk segera ditanggulangi melalui peluncuran program Safe Motherhood. Resolusi PBB pada cakupan kesehatan universal (Universal Health Coverage) pada bulan desember 2012, yang menggaris bawahi bahwa UHC merupakan resolusi yang penting dan mendesak pada semua negara untuk mengembangkan system kesehatan dengan akses yang adil dan biaya yang terjangkau. Hal ini merupakan salah satu program untuk menurunkan AKI dan AKB. Berdasarkan penelitian di tiga Negara yaitu Burkina Faso, Ghana dan Tanzania juga memiliki upaya yang kuat untuk meningkatkan kualitas kesehatan ibu dan bayi (MNH) Selain itu ketiga negara tersebut juga berjuang untuk meningkatkan kinerja dan motivasi para provider. Di Indonesia, berdasarkan Keputusan Menteri Kesehatan Nomor 59 Tahun 2014 Tentang standar pelayanan kesehatan, mewajibkan para bidan bekerjasama dengan BPJS melalui jejaring dokter keluarga yang telah ditunjuk untuk membuat kesepakatan sebagai salah satu tujuan pemerintah untuk meningkatkan pelayanan kesehatan ibu dan anak (KIA).Metode: Penelitian ini merupakan penelitian kualitatif dengan rancangan fenomenologi,. Pengambilan data dilaksanakan dengan metode wawancara mendalam secara langsung menggunakan pedoman wawancara tidak terstruktur, dan pertanyaan terbuka kepada para bidan praktek mandiri sebagai unit analisis. Sampel atau informan di ambil sampai dengan saturasi tertentu atau telah mencapai kecukupan hingga tidak ada lagi data yang perlu digali. Sebagai triangulasi yang dipilih antara lain ketua IBI, Bidan Koordinator/verifikator dasar dan Dokter keluarga.Hasil: Dari hasil penelitian menunjukkan bahwa para bidan memiliki persepsi yang buruk terhadap paket persalinan BPJS saat ini. Meskipun jumlah paketnya lebih besar dari Jampersal, namun tidak semua paket bisa diklaimkan. Penyebabnya antara lain yaitu mekanisme klaim yang dibuat perpaket, prosedur klaimnya rumit dan proses pencairannya lama serta rendahnya tarif persalinan. Sehingga motivasi Bidan Praktek Mandiri (BPM) didalam kerjasama dengan BPJS saat ini relatif kurang. Fenomena yang peneliti temukan yaitu ada beberapa bidan yang meskipun masih terikat kerjasama dengan BPJS tetapi tidak melayani pasien persalinan dengan BPJS. Hal ini terkait dengan rumitnya prosedur paket persalinan BPJS sehingga bidan enggan untuk mengklaim ke BPJS. Fenomena lainnya yaitu para BPM ingin bisa langsung bekerjasama dengan BPJS tanpa melalui jejaring dokter keluarga. Hal ini akibat kurangnya sosialisasi dari BPJS untuk program penguatan layanan primer yang saat ini sedang dicanangkan oleh pemerintah.Kesimpulan: Persepsi Bidan Praktek Mandiri terhadap paket persalinan BPJS masih buruk. Untuk keberlanjutan menjadi provider di dalam jejaring dokter keluarga para BPM masih ingin tetap melanjutkan namun dengan harapan agar mekanisme paket persalinan tidak di buat perpaket dan ada peningkatan tarif persalinan antara 800 ribu sampai 1.5 juta rupiah. Kata Kunci: Persepsi, Bidan Praktek Mandiri, Paket Persalinan, BPJS

PurposeThe aim is to examine the suitability of the educational process in place with the expected professional development.MethodWe conducted in-depth interviews with (a) 16 third-year student who recently completed 2-month clinical rotation in the hospital and (b) four teachers.ResultsEvidence from this study indicate weak learning environment. Clinical instructor only has a limited time to meet with students, so that students rarely get the guidance and direct supervision. Students more often obtain "lessons" of the young staff, which many of them indifferent in providing guidance. Students feel insecure and fear in communicating with senior staff from both the nursing and medical professions. Academic lecturers provide minimum learning support. Their supervision does not allow students to reflect on their experiences.ConclusionProfessional development as reflected in clinical rotations in hospitals is still very limited. The government must monitor more strictly, especially for the medical school located in the district, where professional educators are very limited.

This is a case-control study about the relationship between the qualities of midwifery care, other factors, and the incidence of maternal mortality in the hospitals. Information collected were midwives placement, midwives working environment, and material support in the hospitals. Unmatched midwives placement leads to maternal mortality by 3.86 times compared to the matched midwives placement. Unmatched quality of midwifery care causes maternal mortality by 6.74 times compared to the matched quality midwifery care. Unmatched midwives working leads to maternal mortality by 1.11 times compared to the matched working environment. Also, unmatched support materials causes maternal mortality by 1.55 times compared to the matched support material. There is a relationship between midwives placement and maternal mortality with p< 0.05. There is also a significant relationship of quality of midwifery care to maternal mortality with p< 0.001 in the government-owned hospitals.

People living in isolated communities are vulnerable to suffering from illness because of their lack of access to available known effective treatment in health facilities around them, including in maternal and child issues. The goal of this in-depth interview and one month-direct observation living in the community is to explore the belief and available structure of local health-seeking behavior among the Suku Anak Dalam community. Our findings suggest that the community has its own traditional belief that explains their birth practices. Interpretation of concepts such as anak peranakan, taputangan, pekarom, and delom system are unique and inseparable from the interpretation of their ideal life and their trust in God. In the other side, their poor perception about public health facilities is influenced by their experience dealing with formal health facilities. When a community gets what they perceived as poor services, they will not believe and do not come back to seek help from formal health facilities. Our study confirmed that the cultural explanation of birth and belief related to traditional birth delivery services remain existent and practiced, which limits access to a government health facility. If the community is free to choose alternative care outside their traditional system, people may obtain effective treatments from the surrounding health facilities. SAD women feel comfortable with their cultural practices. They have a negative perception and feel uncomfortable about formal health facilities showed inadequate government efforts to bring services to a specific social group. Health workers in isolated areas with traditional belief should be prepared and paid under a contract basis, different from the regular workers. They need to improve the communication skills that allow them to engage with people from different cultures. They need to work with officers from other sectors, both in formal and informal settings. ; People living in isolated communities are vulnerable to suffering from illness because of their lack of access to available treatment and known to be effective in health facilities around them. Including in these categories is service access for pregnant women. The goal of this in-depth interview and one month-direct observation living in the community is to explore the belief and available structure of local health seeking behavior among Suku Anak Dalam community. Our findings suggest that the community has their own traditional belief that explains their birth practices. Interpretation of concepts such as anak peranakan, taputangan, pekarom, and "delom" system are unique and inseparable from their understanding of their believed ideal life and their trust in God. In other side, their poor perception about public health facilities is influenced by their experience dealing with formal health facilities. When community gets what they percerived as poor services, they will not believe and do not come back to seek help from formal health facilities. Our study confirmed that the cultural explanation of birth and belief related to traditional birth delivery services remain existent and practiced, which limits access of the interior at the health facility. If the community give a choice to their people to find alternative formal health care outside their traditional system, people will no longer suffer from conditions that effective treatments are available in the surrounding health facilities. Women in the community feel comfortable when they are with their traditional system and that they have a bad perception and uncomfortable about formal health facilities shows that inadequate government efforts to bring services to the population. Health workers working in community health centers in the isolated areas with strong traditional belief should be prepared and contracted in different way from the regular workers. They need training to improve their communication skills that allow them to talk and to engage with people from different cultures and to work with the community and people from other sectors both in formal and informal settings.